Background: Although head injury (HI) is a major public health problem in Nigeria and other low and middle income countries of the world, there is a paucity of data from these societies. This is largely due to under-reporting. We carried out a prospective study of the clinicoepidemiological profiles and outcomes following the first hospitalization of a cohort of head-injured patients in Ikeja, Nigeria, a metropolitan African city. Methods: In an 8-month period from May until December 2005, data from all HI cases seen in our neurosurgical unit were prospectively recorded for subsequent analysis. These include demographics, mechanism of injury, pre-neurosurgical care received, severity of injury using the Glasgow Coma Scale, presence of hemodynamic instability, pupillary anomalies and associated systemic injuries, cranial computed tomography (CT) findings and the number of surgical interventions, as well as outcomes after the first hospital admission using the Glasgow Outcome Scale. Determinants of outcome were explored using the χ² test and the level of significance was put at p = 0.05. Results: There were 143 cases of HI, which is about one fifth of our total workload, including 122 males and 21 females aged 0.5–85 years (mean age 29.15). The majority (88%) were either school children or low income earners. Road accidents accounted for 75% of the cases; three quarter of the cases had some initial care in other health facilities before the arrival in our unit, at an average of 33 h. Mild, moderate and severe HI accounted for 60, 18 and 22%, respectively. About a quarter of the patients sustained other systemic injuries. Cranial CT scanning was obtainable in 40 patients (28%); 9 of these revealed surgical mass lesions, of whom 5 had life-saving operations. Many well-known determinants of a poor outcome of HI were prevalent in this study group and found to have a significantly adverse effect on patient outcome. Conclusions: HI is a major public health problem in Nigeria, taking up at least one fifth of the neurosurgical workload. The prehospital emergency medical service is poorly organized. Determinants of a poor outcome of HI are highly prevalent, including poor accessibility to cranial CT scanning, absence or inadequacy of logistics for neurocritical care and an inadequate number of neurosurgeons.

Little or no attention is currently paid to the prevention of CNS congenital anomalies in much of the low- and middle-income countries of the world. There is a great need to regulate the practice of obstetric ultrasonography in Nigeria. There is even a much greater, more fiercely urgent need to ensure periconceptional folic acid supplementation for all women of childbearing age through appropriate food fortification in these societies.

This is a prospective observational study on the profile of central nervous system (CNS) anomalies in a neurosurgical unit in Ikeja, Nigeria. All cases of CNS anomalies seen by the authors in 1 year, January to December 2005, were analyzed. Descriptive variables include some demographics of the patients and their parents; profiles of CNS anomalies, cranial or spinal, neural tube defects (NTD) or others; presence of associated anomalies; and rate of surgical correction of these anomalies. Sixty-one cases were recorded, approximately 64% of our total pediatric neurosurgical output. Forty-one cases were males, 20 females, with a male to female ratio of approximately 2 to 1. The age at presentation ranged from 2 days to 60 months (mean 5.6 months) and the majority of the parents were young (the mean ages of the fathers and mothers were 35 years and 28 years, respectively), and low income earners (70%). The cases comprised cranial (61%) and spinal (39%) anomalies, or 54% of NTD versus others. The cranial lesions were mainly congenital primary hydrocephalus in 44% of cases, encephalocele in 28%, and microcephaly in 17%. The spinal lesions were spinal dysraphism in more than 90%; all in the lumbosacral region. Seventy percent of the NTD had associated cranial or other system anomalies, mainly secondary hydrocephalus in 65%. The surgical correction rate of all of these cases was 38%. NTD were significantly more likely to present early, be associated with other anomalies and undergo surgical correction in this series (P < 0.001). CNS congenital anomalies are under-reported in Nigeria and other developing countries. A call is made for the establishment of nationwide efforts to fully clarify the epidemiology of this silent epidemic.

No abstract